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After decades-old efforts to nudge consumers towards healthier lifestyles through dietary guidelines, diet-related diseases are on the rise. In addition, a growing share of U.S. consumers proactively chooses nutritional supplements as an alternative preventative way of maintaining good health, a $25.5 billion industry in the United States. This paper investigates possible linkages between the economics of consumer supplement choices and the relationship to important dietary and health outcomes. We use National Health and Nutrition Examination Survey (NHANES) data to estimate the impact of nutritional supplements intake on respondent’s body weight outcomes, controlling for diet quality.: The focus of this article is to determine whether nutritional supplements takers differ from non-takers with regard to their health outcomes when controlling for differences in diet quality, based on individual Healthy Eating Index (HEI-2010) score. The analysis applies treatment effects estimators that account for the selection bias and endogeneity of self-reported behavior and diet-health outcomes. The analysis demonstrates a negative association between supplement intake and BMI but no significant effect on an individual’s diet quality. Our findings suggest that individuals proactively invest into their health by taking nutritional supplements instead of improving diet quality through more nutritious food choices. Our results provide important contributions to the literature on a key food policy issue. Knowledge of the determinants of supplement demand in the context of strong diet-health trends should also be helpful to stakeholders in the U.S. produce sector in their competition over consumer market share. [ABSTRACT FROM AUTHOR]

The goal of this paper is to estimate peer influence in video gaming time among adolescents. Using a nationally representative sample of the U.S. school-aged adolescents in 2009–2010, we estimate a structural model that accounts for the potential biases in the estimate of the peer effect. Our peer group is exogenously assigned and includes one year older adolescents in the same school grade as the respondent. The peer measure is based on peers’ own reports of video gaming time. We find that an additional one hour of playing video games per week by older grade-mates results in .47 hours increase in video gaming time by male responders. We do not find significant peer effect among female responders. Effective policies aimed at influencing the time that adolescents spend video gaming should take these findings into account. [ABSTRACT FROM AUTHOR]

Background: Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states.Methods and Findings: State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust.Conclusions: Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment. [ABSTRACT FROM AUTHOR]

Objectives: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods: We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results: Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions: This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability. [ABSTRACT FROM AUTHOR]

Background: College affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states-including California, Texas, and Michigan-banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents.Methods and Findings: We conducted a difference-in-differences analysis using data from the 1991-2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th-12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: -0.1, 7.2, p = 0.058), among underrepresented minority 11th-12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes.Conclusions: In this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences. [ABSTRACT FROM AUTHOR]

This study examines the potential for point-of-decision prompts (PDPs) to promote healthier food choices among shoppers in a rural, low-income, minority community. We hypothesized that a narrowly defined PDP (focused on fresh produce) would be easier for shoppers to remember than a broadly defined PDP (focused on any healthy items), resulting in a higher proportion of healthy items purchased. PDPs were placed at the entrance to a supermarket in Mission, South Dakota, United States of America, on the Rosebud Sioux Reservation for alternating time periods, July 9–10, 2017. Sales records from 653 transactions were retrieved from the supermarket, comprising periods in which PDPs were in place and control periods. We examined the proportion of selected items and proportion of total expenditures that were a) any healthy foods and b) fresh fruits and vegetables. Data were analyzed in 2018. The narrowly defined prompt consistently resulted in a higher proportion of items and expenditures on healthy foods than either the broad prompt or the control condition. Shoppers in the narrow prompt condition purchased and spent significantly more on any healthy foods and fresh produce than shoppers in the control condition. While shoppers in the narrow prompt condition purchased more healthy foods and fresh produce than shoppers in the broad prompt condition, the differences were not statistically significant. Shoppers exposed to the narrow PDP consistently purchased more healthy foods than shoppers in a control group, while shoppers in the broad PDP did not, highlighting the importance of considering cognitive processes when designing health promotion messages. [ABSTRACT FROM AUTHOR]

Theoretical approaches suggest that gender inequity increases men’s health risks. Previous findings from the United States support this contention, however only a small number of health outcomes have been explored. This study extends the range of health outcomes examined by using a cross-sectional, multilevel analysis to investigate whether measures of state-level gender inequity are predictors of men’s self-rated health. Data were derived primarily from the Behavioral Risk Factor Surveillance System and the full-case data set included 116,594 individuals nested within 50 states. Gender inequity was measured with nine variables: higher education, women’s reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and gross domestic product per capita. In fully adjusted models for all-age men the reproductive rights (OR 1.06 95% CI 1.01–1.11), abortion provider access (OR 1.11 95% CI 1.05–1.16) and earnings (OR 1.06 95% CI 1.02–1.12) measures all predicted an increased risk of men reporting poorer self-rated health for each 1 standard deviation increase in the gender inequity z-score. The most consistent effect was seen for the 65+ age group where the reproductive rights (OR 1.09 95% CI 1.03–1.16), abortion provider access (OR 1.15 95% CI 1.09–1.21), elected office (OR 1.06 95% CI 1.01–1.11) and earnings (OR 1.10 95% CI 1.04–1.16) measures all showed a significant effect. These findings provide evidence that some aspects of gender inequity increase the risk of poorer self-rated health in men. The study contributes to a growing body of literature implicating gender inequity in men’s health patterns. [ABSTRACT FROM AUTHOR]

Introduction: Amazon’s Mechanical Turk (MTurk) is frequently used to administer health-related surveys and experiments at a low cost, but little is known about its representativeness with regards to health status and behaviors. Methods: A cross-sectional survey comprised of questions from the nationally-representative 2014 Behavioral Risk Factor Surveillance System (BRFSS) and 2014 National Health and Nutrition Examination Survey (NHANES) was administered to 591 MTurk workers and 393 masters in 2016. Health status (asthma, depression, BMI, and general health), health behaviors (influenza vaccination, health insurance, smoking, and physical activity), and demographic characteristics of the two MTurk populations (workers and masters) were compared to each other and, using Poisson regression, to a nationally-representative BRFSS and NHANES samples. Results: Workers and master demographics were similar. MTurk users were more likely to be aged under 50 years compared to the national sample (86% vs. 55%) and more likely to complete a college degree than the national sample (50% vs. 26%). Adjusting for covariates, MTurk users were less likely to be vaccinated for influenza, to smoke, to have asthma, to self-report being in excellent or very good health, to exercise, and have health insurance but over twice as likely to screen positive for depression relative to a national sample. Results were fairly consistent among different age groups. Conclusions: MTurk workers are not a generalizable population with regards to health status and behaviors; deviations did not follow a trend. Appropriate health-related uses for MTurk and ways to improve upon the generalizability of MTurk health studies are proposed. [ABSTRACT FROM AUTHOR]

The HPTN 065 (TLC-Plus) study tested the feasibility and effectiveness of using financial incentives (FIs) to increase linkage to care (L2C) among individuals with newly diagnosed HIV and those out of care in the Bronx, NY and Washington, DC. Qualitative data collection with a subset of participating patients and staff focused on experiences with and attitudes about the FI intervention. Semi-structured interviews were conducted with 15 patients and 14 site investigators. Four focus group discussions were conducted with a total of 15 staff members. The use of FIs for L2C was generally viewed favorably. Patients were grateful and benefited financially, but sites had some challenges implementing the program. Challenges included the timing and sensitive introduction of the intervention immediately after an HIV diagnosis, negative attitudes towards paying people for health behaviors, and the existence and strength of existing linkage programs. Future programs should consider optimal timing and presentation of FIs. [ABSTRACT FROM AUTHOR]

HIV infection disproportionately affects Blacks in the southern United States (U.S.), a region where legal policies that may unintentionally impede earlier HIV detection and treatment are prevalent. Historically Black Colleges and Universities (HBCUs) have historically facilitated social change in communities of color and have been underexplored as partners for HIV prevention. We describe geographic and social determinants of health (SDH) in the southern U.S. to inform potential HBCU-public health partnerships that might improve HIV health equity. We evaluated the relationship between county-level HIV prevalences (2013), HBCU geographic coordinates, and SDH variables in the southern counties with HBCUs. U.S. Census-derived SDH variables included race/ethnicity (i.e., Black, White, Hispanic), unemployment, female head of household, poverty, percent owner-occupied housing units, urbanicity, and primary care provider rates. Associations were assessed using bivariate and multivariable linear regression. Of 104 HBCUs in the contiguous U.S., 100 (96%) were located in 69 southern counties with average Black populations of 40% and an average HIV prevalence of 615. 5 per 100,000, over two times the national rate (295.1 per 100,000). In bivariable analyses, higher HIV rates in these counties were associated with higher percent Black population, unemployment, female head of household, poverty, fewer owner-occupied housing units, and greater urbanicity (p < 0.05). In multivariable analyses, counties with higher HIV rates had higher percentages of Blacks, greater urbanicity, fewer owner-occupied housing units, and more female heads of households (p < 0.05). The southern U.S. is disproportionately affected by HIV, and many HBCUs are located in affected southern counties. HBCUs may be important public health partners for helping to develop structural interventions that strengthen HIV policies in support of health equity in these southern, mostly urban counties. [ABSTRACT FROM AUTHOR]

Research with humans and other animals suggests that walking benefits physical health. Perhaps because these links have been demonstrated in other species, it has been suggested that walking is important to elephant welfare, and that zoo elephant exhibits should be designed to allow for more walking. Our study is the first to address this suggestion empirically by measuring the mean daily walking distance of elephants in North American zoos, determining the factors that are associated with variations in walking distance, and testing for associations between walking and welfare indicators. We used anklets equipped with GPS data loggers to measure outdoor daily walking distance in 56 adult female African (n = 33) and Asian (n = 23) elephants housed in 30 North American zoos. We collected 259 days of data and determined associations between distance walked and social, housing, management, and demographic factors. Elephants walked an average of 5.3 km/day with no significant difference between species. In our multivariable model, more diverse feeding regimens were correlated with increased walking, and elephants who were fed on a temporally unpredictable feeding schedule walked 1.29 km/day more than elephants fed on a predictable schedule. Distance walked was also positively correlated with an increase in the number of social groupings and negatively correlated with age. We found a small but significant negative correlation between distance walked and nighttime Space Experience, but no other associations between walking distances and exhibit size were found. Finally, distance walked was not related to health or behavioral outcomes including foot health, joint health, body condition, and the performance of stereotypic behavior, suggesting that more research is necessary to determine explicitly how differences in walking may impact elephant welfare. [ABSTRACT FROM AUTHOR]

Several contagious diseases were nearly eradicated through childhood vaccination, but some parents have decided in recent years not to fully vaccinate their children, raising new public health concerns. The question of whether and how beliefs about vaccination are linked to political ideology has been hotly debated. This study investigates the effects of ideology on perceptions of harms and benefits related to vaccination as well as judgments of others’ attitudes. A total of 367 U.S. adults (131 men, 236 women; Mage = 34.92 years, range = 18–72) completed an online survey through Mechanical Turk. Results revealed that liberals were significantly more likely to endorse pro-vaccination statements and to regard them as “facts” (rather than “beliefs”), in comparison with moderates and conservatives. Whereas conservatives overestimated the proportion of like-minded others who agreed with them, liberals underestimated the proportion of others who agreed with them. That is, conservatives exhibited the “truly false consensus effect,” whereas liberals exhibited an “illusion of uniqueness” with respect to beliefs about vaccination. Conservative and moderate parents in this sample were less likely than liberals to report having fully vaccinated their children prior to the age of two. A clear limitation of this study is that the sample is not representative of the U.S. population. Nevertheless, a recognition of ideological sources of potential variability in health-related beliefs and perceptions is a prerequisite for the design of effective forms of public communication. [ABSTRACT FROM AUTHOR]

Sustainable development efforts in urban areas often focus on understanding and managing factors that influence all aspects of health and wellbeing. Research has shown that public parks and green space provide a variety of physical, psychological, and social benefits to urban residents, but few studies have examined the influence of parks on comprehensive measures of subjective wellbeing at the city level. Using 2014 data from 44 U.S. cities, we evaluated the relationship between urban park quantity, quality, and accessibility and aggregate self-reported scores on the Gallup-Healthways Wellbeing Index (WBI), which considers five different domains of wellbeing (e.g., physical, community, social, financial, and purpose). In addition to park-related variables, our best-fitting OLS regression models selected using an information theory approach controlled for a variety of other typical geographic and socio-demographic correlates of wellbeing. Park quantity (measured as the percentage of city area covered by public parks) was among the strongest predictors of overall wellbeing, and the strength of this relationship appeared to be driven by parks’ contributions to physical and community wellbeing. Park quality (measured as per capita spending on parks) and accessibility (measured as the overall percentage of a city’s population within ½ mile of parks) were also positively associated with wellbeing, though these relationships were not significant. Results suggest that expansive park networks are linked to multiple aspects of health and wellbeing in cities and positively impact urban quality of life. [ABSTRACT FROM AUTHOR]

Background: The extent to which patients with COPD are receiving indicated treatment with medications to improve lung function and recent trends in the use of these medications is not well documented in the United States. The objective of this study was to examine trends in prescription medications for COPD among adults in the United States from 1999 to 2010. Methods: We performed a trend analysis using data from up to 1426 participants aged ≥20 years with self-reported COPD from six national surveys (National Health and Nutrition Examination Survey 1999–2010). Results: During 2009–2010, the age-adjusted percentage of participants who used any kind of medication was 44.2%. Also during 2009–2010, the most commonly used medications were short-acting agents (36.0%), inhaled corticosteroids (ICS) (18.3%), and LABAs (16.7%). The use of long-acting beta-2 agonists (LABAs) (p for trend <0.001), ICS (p for trend = 0.013) increased significantly over the 12-year period. Furthermore, the use of tiotropium increased rapidly during this period (p for trend <0.001). For the years 2005–2010, the use of LABAs, ICS and tiotropium increased with age. Compared with whites, Mexican Americans were less likely to use short-acting agents, LABAs, ICS, tiotropium, and any kind of COPD medication. Among participants aged 20–79 years with spirometry measurements during 2007–2010, the use of any medication was reported by 19.0% of those with a moderate/severe obstructive impairment and by 72.6% of those with self-reported COPD and any obstructive impairment. Conclusion: The percentages of adults with COPD who reported having various classes of prescription medications that improve airflow limitations changed markedly from 1999–2000 to 2009–2010. However, many adults with COPD did not report having recommended prescription medications. [ABSTRACT FROM AUTHOR]

Abstract: Autism is on the rise, with 1 in 88 children receiving a diagnosis in the United States, yet the process for diagnosis remains cumbersome and time consuming. Research has shown that home videos of children can help increase the accuracy of diagnosis. However the use of videos in the diagnostic process is uncommon. In the present study, we assessed the feasibility of applying a gold-standard diagnostic instrument to brief and unstructured home videos and tested whether video analysis can enable more rapid detection of the core features of autism outside of clinical environments. We collected 100 public videos from YouTube of children ages 1–15 with either a self-reported diagnosis of an ASD (N = 45) or not (N = 55). Four non-clinical raters independently scored all videos using one of the most widely adopted tools for behavioral diagnosis of autism, the Autism Diagnostic Observation Schedule-Generic (ADOS). The classification accuracy was 96.8%, with 94.1% sensitivity and 100% specificity, the inter-rater correlation for the behavioral domains on the ADOS was 0.88, and the diagnoses matched a trained clinician in all but 3 of 22 randomly selected video cases. Despite the diversity of videos and non-clinical raters, our results indicate that it is possible to achieve high classification accuracy, sensitivity, and specificity as well as clinically acceptable inter-rater reliability with nonclinical personnel. Our results also demonstrate the potential for video-based detection of autism in short, unstructured home videos and further suggests that at least a percentage of the effort associated with detection and monitoring of autism may be mobilized and moved outside of traditional clinical environments. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity, ambient air pollution and obesity are modifiable risk factors for non-communicable diseases, with the first accounting for 10% of premature deaths worldwide. Although community level interventions may target each simultaneously, research on the relationship between these risk factors is lacking. Objectives: After comparing spatial interpolation methods to determine the best predictor for particulate matter (PM2.5; PM10) and ozone (O3) exposures throughout the U.S., we evaluated the cross-sectional association of ambient air pollution with leisure-time physical inactivity among adults. Methods: In this cross-sectional study, we assessed leisure-time physical inactivity using individual self-reported survey data from the Centers for Disease Control and Prevention's 2011 Behavioral Risk Factor Surveillance System. These data were combined with county-level U.S. Environmental Protection Agency air pollution exposure estimates using two interpolation methods (Inverse Distance Weighting and Empirical Bayesian Kriging). Finally, we evaluated whether those exposed to higher levels of air pollution were less active by performing logistic regression, adjusting for demographic and behavioral risk factors, and after stratifying by body weight category. Results: With Empirical Bayesian Kriging air pollution values, we estimated a statistically significant 16–35% relative increase in the odds of leisure-time physical inactivity per exposure class increase of PM2.5 in the fully adjusted model across the normal weight respondents (p-value<0.0001). Evidence suggested a relationship between the increasing dose of PM2.5 exposure and the increasing odds of physical inactivity. Conclusions: In a nationally representative, cross-sectional sample, increased community level air pollution is associated with reduced leisure-time physical activity particularly among the normal weight. Although our design precludes a causal inference, these results provide additional evidence that air pollution should be investigated as an environmental determinant of inactivity. [ABSTRACT FROM AUTHOR]

Childhood family structure has been shown to play an important role in shaping a child's life course development, especially in industrialised societies. One hypothesis which could explain such findings is that parental investment is likely to be diluted in families without both natural parents. Most empirical studies have examined the influence of only one type of family disruption or composition (e.g. father absence) making it difficult to simultaneously compare the effects of different kinds of family structure on children's future outcomes. Here we use a large, rich data source (n = 16,207) collected by Alfred Kinsey and colleagues in the United States from 1938 to 1963, to examine the effects of particular childhood family compositions and compare between them. The dataset further allows us to look at the effects of family structure on an array of traits relating to sexual maturity, reproduction, and risk-taking. Our results show that, for both sexes, living with a single mother or mother and stepfather during childhood was often associated with faster progression to life history events and greater propensity for risk-taking behaviours. However, living with a single father or father and stepmother was typically not significantly different to having both natural parents for these outcomes. Our results withstand adjustment for socioeconomic status, age, ethnicity, age at puberty (where applicable), and sibling configuration. While these results support the hypothesis that early family environment influences subsequent reproductive strategy, the different responses to the presence or absence of different parental figures in the household rearing environment suggests that particular family constructions exert independent influences on childhood outcomes. Our results suggest that father-absent households (i.e. single mothers or mothers and stepfathers) are most highly associated with subsequent fast life history progressions, compared with mother-absent households, and those with two natural parents. [ABSTRACT FROM AUTHOR]

Background: American Black men who have sex with men (MSM) are disproportionately affected by HIV, but the factors associated with this concentrated epidemic are not fully understood. Methods: Black MSM were enrolled in 6 US cities to evaluate a multi-component prevention intervention, with the current analysis focusing on the correlates of being newly diagnosed with HIV compared to being HIV-uninfected or previously diagnosed with HIV. Results: HPTN 061 enrolled 1553 Black MSM whose median age was 40; 30% self-identified exclusively as gay or homosexual, 29% exclusively as bisexual, and 3% as transgender. About 1/6th (16.2%) were previously diagnosed with HIV (PD); of 1263 participants without a prior HIV diagnosis 7.6% were newly diagnosed (ND). Compared to PD, ND Black MSM were younger (p<0.001); less likely to be living with a primary partner (p<0.001); more likely to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.011) or chlamydia (p = 0.020). Compared to HIV-uninfected Black MSM, ND were more likely to report unprotected receptive anal intercourse (URAI) with a male partner in the last 6 months (p<0.001); and to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.004), and urethral (p = 0.025) or rectal chlamydia (p<0.001). They were less likely to report female (p = 0.002) or transgender partners (p = 0.018). Multivariate logistic regression analyses found that ND Black MSM were significantly more likely than HIV-uninfected peers to be unemployed; have STIs, and engage in URAI. Almost half the men in each group were poor, had depressive symptoms, and expressed internalized homophobia. Conclusions: ND HIV-infected Black MSM were more likely to be unemployed, have bacterial STIs and engage in URAI than other Black MSM. Culturally-tailored programs that address economic disenfranchisement, increase engagement in care, screen for STIs, in conjunction with safer sex prevention interventions, may help to decrease further transmission in this heavily affected community. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. Results: We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. Conclusions: This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden. [ABSTRACT FROM AUTHOR]

Background: HPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population. Methods: This is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10–26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009. Results: Adults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series. Conclusions: HPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between TV viewing and obesity by race/ethnicity and socio-economic status. Design: Cross-sectional analysis of 5,087 respondents to the Health Information National Trends Survey (HINTS), a nationally representative sample of US adults. Multivariate regression models were computed to assess the association between quartiles of TV viewing and BMI, stratified by race/ethnicity, educational attainment, employment and health insurance status. Results: Findings indicate that increased TV viewing was associated with higher odds for being overweight/obese in the entire sample, while adjusting for physical activity and other confounders. After stratification by race/ethnicity, increased odds for overweight/obesity in the 3rd and 4th quartiles of TV viewing (e.g., 3rd quartile- cumulative OR = 1.43, 95%CI 1.07–1.92) was observed in non-Hispanic whites, with statistical significance. In non-Hispanic blacks and Hispanics, the odds were similar to whites, but did not reach statistical significance. Significant relations between greater TV viewing and increased BMI were observed in college graduates and non-graduates, those with health insurance and the employed. Conclusions: This study extends previous research by examining potential inconsistencies in this association between various racial/ethnic groups and some socio-economic variables, which primarily were not found. [ABSTRACT FROM AUTHOR]

Background: COPD is characterized by variability in exercise capacity and physical activity (PA), and acute exacerbations (AEs). Little is known about the relationship between daily step count, a direct measure of PA, and the risk of AEs, including hospitalizations. Methods: In an observational cohort study of 169 persons with COPD, we directly assessed PA with the StepWatch Activity Monitor, an ankle-worn accelerometer that measures daily step count. We also assessed exercise capacity with the 6-minute walk test (6MWT) and patient-reported PA with the St. George's Respiratory Questionnaire Activity Score (SGRQ-AS). AEs and COPD-related hospitalizations were assessed and validated prospectively over a median of 16 months. Results: Mean daily step count was 5804±3141 steps. Over 209 person-years of observation, there were 263 AEs (incidence rate 1.3±1.6 per person-year) and 116 COPD-related hospitalizations (incidence rate 0.56±1.09 per person-year). Adjusting for FEV1 % predicted and prednisone use for AE in previous year, for each 1000 fewer steps per day walked at baseline, there was an increased rate of AEs (rate ratio 1.07; 95%CI = 1.003–1.15) and COPD-related hospitalizations (rate ratio 1.24; 95%CI = 1.08–1.42). There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs (P = 0.008) and COPD-related hospitalizations (P = 0.003). Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 (95%CI = 1.01–1.14) for AEs and 1.18 (95%CI = 1.07–1.30) for COPD-related hospitalizations. Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 (95%CI = 1.01–1.09) for AEs and 1.10 (95%CI = 1.02–1.17) for COPD-related hospitalizations. Conclusions: Lower daily step count, lower 6MWT distance, and worse SGRQ-AS predict future AEs and COPD–related hospitalizations, independent of pulmonary function and previous AE history. These results support the importance of assessing PA in patients with COPD, and provide the rationale to promote PA as part of exacerbation-prevention strategies. [ABSTRACT FROM AUTHOR]

Increased sedentary behavior and lack of physical activity are associated with increased risk for many chronic diseases. Differences in leisure-time physical activity between African American and white adults have been suggested to partially explain racial disparities in chronic disease outcomes, but expanding the definition of physical activity to include household and occupational activities may reduce or even eliminate racial differences in total physical activity. The objective of this study was to describe patterns of active and sedentary behaviors in black and white adults and to examine these behaviors across demographic measures. Sedentary and physically active behaviors were obtained from a validated physical activity questionnaire in 23,021 black men, 9,899 white men, 32,214 black women, and 15,425 white women (age 40–79) at enrollment into the Southern Community Cohort Study. Descriptive statistics for sedentary time; light, moderate, and vigorous household/occupational activity; sports/exercise; total activity; and meeting current physical activity recommendations via sports/exercise were examined for each race-sex group. Adjusted means were calculated using multiple linear regression models across demographic measures. Study participants spent approximately 60% of waking time in sedentary behaviors. Blacks reported more television viewing time than whites (45 minutes for females, 15 minutes for males), but when sitting time was expressed as a proportion of overall awake time, minimal racial differences were found. Patterns of light, moderate, and vigorous household/occupational activity were similar in all race/sex groups. 2008 Physical Activity Guidelines for Americans were followed by 16% of women and 25% of men independent of race. Overall, black and white men and women in this study spent the majority of their daily time in sedentary behaviors and less than one-fourth followed current guidelines for physical activity. These results indicate that public health campaigns should focus on both reducing sedentary behavior and increasing physical activity in all adult US populations. [ABSTRACT FROM AUTHOR]

Objectives: Smoking among migrants is known to differ from the host population, but migrants’ smoking is rarely ever compared to the prevalence of smoking in their country of origin. The goal of this study is to compare the smoking prevalence among migrants to that of both the US-born population and the countries of origin. Further analyses assess the influence of sex, age at time of entry to the US and education level. Methods: Data of 248,726 US-born and migrants from 14 countries were obtained from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) from 2006–2007. Data on 108,653 respondents from the corresponding countries of origin were taken from the World Health Survey (WHS) from 2002–2005. Results: The prevalence of smoking among migrants (men: 14.2%, women: 4.1%) was lower than both the US-born group (men: 21.4%, women: 18.1%) and countries of origin (men: 39.4%, women: 11.0%). The gender gap among migrants was smaller than in the countries of origin. Age at time of entry to the US was not related to smoking prevalence for migrants. The risk of smoking for high-educated migrants was closer to their US counterparts. Conclusions: The smoking prevalence among migrants is consistently lower than both the country of origin levels and the US level. The theory of segmented assimilation is supported by some results of this study, but not all. Other mechanisms that might influence the smoking prevalence among migrants are the ‘healthy migrant effect’ or the stage of the smoking epidemic at the time of migration. [ABSTRACT FROM AUTHOR]

Background: The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. Methods and Findings: An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean  = 5.74). Perceived benefit was greatest for the United States (mean  = 5.56) and self (mean  = 5.39) compared to the target population (mean  = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R2  = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean  = 6.10) than either Army (mean  = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean  = 5.60, Cohen's d  = 0.46, p<.01) physicians. Conclusions: Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals. [ABSTRACT FROM AUTHOR]

Background and Aims: Anecdotal reports and studies of select populations suggest that the use of proton pump inhibitors (PPIs) has increased since their introduction. We sought to determine recent trends in PPI use in the U.S. outpatient setting and characteristics of patients and physicians that may predict their use. Methods: We used data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to estimate the prevalence of visits in which patients used PPIs from 2002 to 2009. We tested for associations between PPI use and patient, physician, and practice characteristics using data from 2009. We also estimated the prevalence of visits in which PPIs were used by patients without gastrointestinal complaints, diagnoses, or other indications for their use and tested for associations between patient and physician characteristics and PPI use in patients with no documented indication. Results: PPIs were used in 4.0% of visits in 2002 and 9.2% in 2009 (p<0.001 for trend across years). The use of omeprazole (0.9% in 2002 to 3.9% in 2009, p<0.001), esomeprazole (0.9% in 2002 to 2.3% in 2009, p<0.001), and pantoprazole (0.6% in 2002 to 1.6% in 2009, p<0.001) increased significantly over the study period. Among visits by patients using PPIs, 62.9% documented no gastrointestinal complaints, gastrointestinal diagnoses, or other indicated reason for their use. Conclusions: We found that PPI use increased significantly from 2002 to 2009 as did documented indications for their use. Newly-prescribed PPI use did not change from 2006 to 2009. More research is needed to determine whether PPIs are overused in the U.S. outpatient setting. [ABSTRACT FROM AUTHOR]